Provider Demographics
NPI:1710701370
Name:KOLB, MICAH D I
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:D
Last Name:KOLB
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 COUNTY ROAD 2934
Mailing Address - Street 2:
Mailing Address - City:ALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75410-5584
Mailing Address - Country:US
Mailing Address - Phone:903-497-8687
Mailing Address - Fax:
Practice Address - Street 1:353 COUNTY ROAD 2934
Practice Address - Street 2:
Practice Address - City:ALBA
Practice Address - State:TX
Practice Address - Zip Code:75410-5584
Practice Address - Country:US
Practice Address - Phone:903-497-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15980101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)